Prognostic impact of lateral sentinel lymph node biopsy using indocyanine green on oncological outcomes for clinical stage II/III lower rectal cancer without suspected lateral lymph node metastasis

Toshinori Sueda ^1,2, Masayoshi Yasui ³, Junichi Nishimura ³

⁰Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan. sueda811@yahoo.co.jp.

Langenbeck's Archives of Surgery +

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October 18, 2024

View abstract on PubMed

Summary

Sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) showed similar oncological outcomes to lateral lymph node dissection (LLND) in lower rectal cancer. This suggests SLNB can help determine the need for LLND, potentially improving patient management.

Area Of Science

Surgical Oncology
Rectal Cancer Management
Minimally Invasive Techniques

Background

Sentinel lymph node biopsy (SLNB) is established for detecting metastasis in rectal cancer.
Indocyanine green (ICG)-guided SLNB has shown safety and feasibility in clinical stage II/III lower rectal cancer (RC).
The oncological impact of lateral pelvic SLNB using ICG remains under investigation.

Purpose Of The Study

To evaluate the prognostic impact of lateral pelvic SLNB on oncological outcomes.
To compare outcomes of ICG-guided SLNB with prophylactic lateral lymph node dissection (LLND) in lower rectal cancer.

Main Methods

A cohort study included 150 patients with clinical stage II/III lower RC from January 2010 to December 2020.
Patients underwent either lateral pelvic SLNB or prophylactic LLND (Non-SLNB).
Primary endpoint was 5-year cumulative incidence of local recurrence (LR); secondary endpoints included survival rates and recurrence-free survival.

Main Results

No significant differences in local recurrence (LR) or survival outcomes (CSS, OS, RFS, LRFS, DRFS) were observed between SLNB and Non-SLNB groups.
Of 79 SLNB patients, 4 positive cases underwent LLND; 75 negative cases omitted LLND.
Median follow-up was 61.0 months; overall recurrence rate was 30.7%.

Conclusions

Oncological outcomes were comparable between ICG-guided SLNB and prophylactic LLND groups.
ICG-guided SLNB shows promise for guiding the indication for LLND in lower rectal cancer.
This technique may help personalize treatment strategies and avoid unnecessary dissection.

Keywords:

Lateral pelvic lymph node dissection Oncological outcome Rectal cancer Sentinel lymph node biopsy